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September 22, 2003

Daily Care

Question from :

DTQ-20030915125755 From Port Orchard, Washington, USA: My daughter is currently on Humalog with Lantus at bedtime. Her daytime numbers tend to be good (with occasional lows in the afternoons, and her bedtime numbers are generally within range, but her morning numbers are pretty consistently in the 200s mg/dl [11.1 mmol/L]. She eats a small snack at 8:00 pm, and when I do nighttime checks, the numbers vary. Do you think the dosage, or timing of the Lantus may be the problem? Is it something else entirely?

Answer:

I think about the bedtime glucose and the morning glucose. If the Lantus is right they should be close. Obviously, there is a bit of a peak in the night so you want to be sure she doesn’t get low.

Sometimes, people find it hard to give Lantus at close to the same time. Then it is a lot easier to give two shots (morning and bedtime whenever it is).

Look at the insulin to carb ratios and the correction ratios. I use the rule of 1800 for most kids (sensitivity is 1800 divided by 24 hour insulin dose) to calculate the ratio and try to get to a reasonable bedtime level.

LD